| NPI | 1700486685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NC 5014135) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5014135) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5014135) | |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2023-04-24 |